Biography

My family is Chinese, but I grew up in post-war Japan, came to the U.S. for college. Received my BA from Columbia U in NY, and my M.D. from University of Southern California, LA. House staff training at Rush-Presbyterian-St Lukes Medical Center in Chicago, and finally Stanford University for nephrology fellowship.

My first job in 1977 was my last, with the El Camino Renal Medical Group, at El Camino Hospital. In those 40 years here, I have been active and engaged in clinical, financial and political aspects. I served as Chief of Medicine, Chief of Staff, was appointed Medical Director of Physician Quality Assurance, and for 25 years was the Medical Director for the Dialysis service line. I taught at Stanford Medical School for 30 years, now am Clinical Professor Emeritus of Medicine. I have been on numerous Medical Advisory and Editorial Boards. I was the CEO of the family business in Japan for 6 years.

My greatest unfinished challenge at El Camino Hospital is forging the partnerships the Hospital needs to remain independent and vibrant. Its greatest advantage is geography; its greatest weakness being a stand-alone community hospital, without is own cadre of physicians as partners. PAMF and Stanford have excellent and successful physicians, make excellent clinical partners, but their true loyalties are to their own organizations. The Independent Physicians, potentially the best Hospital partners, are in disarray, disappearing at an alarming rate. The reason is that as individuals, they have no negotiating power, and receive less than half for the same work, compared to physicians in large groups.

I am concerned about the Hospital's plan to develop its own physicians, the El Camino Medical Associates, as they have not addressed the fundamental weakness of poor reimbursement rates, are not successful at managing or growing their physicians, and paying them below market rates. I have advocated reviewing and tightening the operations of the ECMA. I have also advocated forming alliances with specific Medical Foundations (who have better rates, as do the Palo Alto Medical Foundation) at other Hospitals which help both them and us get better rates.

I feel the only way for my proposals to get the proper attention and review is by my running for the District Board. I have no desire to disrupt plans that work well. I do want proper review of expensive plans which appear to be doing poorly, and be open to considering alternative options.

The Hospital made over $180 million last year. The Hospital's financial performance has always been good, due in large part to its location, not having competing hospitals nearby, and having robust physician practices referring patients. Healthcare will change, and as providers become more integrated, there will be greater influence by the physician groups on Hospital decision-making. I want us to start preparing now, as these changes are well under way.

If my suggestions do help in the long run, the end result will be some stabilization of the practices of Independent Physicians, and greater security fo rhte Hospital's future independence.

Political Beliefs

Political Philosophy

As a socially liberal but financially conservative voter, I believe money has to be spent carefully and strategically. Therefore I believe voters must have as much information as possible to make good decisions, and this requires transparency, especially of public organizations. What I seek in leaders is that they place the common good above narrow interests, such as their own party, or their own interests. I believe money distorts too much of the decision-making in this country. It can put candidates who have extreme positions in office, and it can buy legislation. I believe campaign reform would go a long way to having the voice of the people be heard.

I believe in universal healthcare, that it should be non-profit, have a single or very few payers all playing by the same rules, have budgetary caps on healthcare spending, and have providers compete on the basis of quality and satisfaction, not volume of services. This would accomplish a lot of things.

Universal healthcare. I think it is shameful that this great country cannot ensure essential healthcare for all its citizens and residents. The greatest cause for bankruptcy is a major health problem. We can do better, but only if we demand it of our public officials. Americans, particularly the working poor, and disproportionately too many children, suffer for lack of basic medical care.

"Medicare for all" is the current catch phrase, but it is important to define what that is. Standard Medicare is fee-for-service, and there are no cost constraints on the volume of care. Therefore Medicare spending just keeps growing. However, Medicare Managed Care does cap spending, because like Medi-Cal, there is only so much money, and providers must figure out how to spend it wisely. It also forces providers to be more integrated, so hospitals do not compete with doctor groups and vice versa. The focus is on streamlining care, not who can do more.

The goal becomes taking the best care of people (since healthier people are less expensive, and simply doing more is not always good). However, there must be robust competition on quality outcomes and satisfaction.

Estimates on cost savings from such a plan is 15-20% of the $3.3 trillion spent annually. The main reduction would be the profit made by insurance companies. Although shareholders may like the current system, it is too high a price when millions are uninsured. Reducing unnecessary competition and volume incentives would save at least 5%. There are studies showing savings of $400 to $500 billion per year. Cover more people, save a lot of money. That's a pretty good deal.

Accomplishing this is near impossible, given the amount of money at stake, and having politicians not really solving the big problems. However, other industrialized countries have accomplished systems that work better than ours, and we should be able to do better too.

As much as I would like to see a leader rise to the occasion, and have legislature that works for the good of the citizens and residents of this country, I believe it ultimately depends on each one of us to understand the issues, and demand progress. This starts at the local level, in electing the right officials.

I would start with the right Healthcare District Board member!

Position Papers

TING: Priorities and Issues

Summary

What are the top priorities at El Caminno Hospital.

What I think we need to do about them.

PRIORITIES & ISSUES

THE RIGHT STRATEGIC PLAN

Nothing is more important for any Board of Directors than to get right the strategic plan. Currently, we have good plans in many, but not all areas. The three top priorities are clinical excellence, financial performance, and clinical partnerships.

CLINICAL EXCELLENCE

·This is where experienced physicians on the Board are critical. The leadership for clinical excellence must come from the very top: the Board. It must be clinically credible and inspiring.

·The Board must support innovative and clinically proven programs. It must insist on being able to objectively demonstrate its success by measuring, and continuously improving clinical processes, outcomes and satisfaction.

FINANCIAL PERFORMANCE

·We have had a very good year financially, and I will build on these successes. We need to be vigilant about controlling costs, especially in good times. We all now that is when we can over-commit.

·Finances must change as reimbursement is more based on value (population management) rather than the volume of services it provides. This transition requires a sure hand, not too fast, not too slow.

CLINICAL PARTNERSHIPS

Physicians bring patients, the lifeblood of any hospital. Healthcare is changing rapidly and physicians and hospitals will be more interdependent. We need the right physician partnerships to remain independent.

PAMF and Stanford physicians are excellent, but belong to other organizations. If ECH must have its own cadre of physicians as partners to retain control of its own destiny. (Why is that important? Santa Theresa used to be an open hospital. Once Kaiser doctors were the big majority, it took it over and it is now Kaiser-Santa Theresa, only for Kaiser patients)

·ECH's current strategy is to hire and grow its own group of doctors as its future partner, the El Camino Medical Associates (ECMA). An incumbent Board member has indicated they plan to form a new ECH medical foundation.

·As it stands, this plan has significant flaws:

oThe main one is that forming a new Foundation is not the right answer now. We are very late to the game; Foundations at other hospitals are already up and successful. We do not need the expense or risk to try to create a new one: we should join an existing successful one, but require self-governance. Just as PAMF does not form a new foundation whenever a new medical group joins, it expands its existing successful one. Forming a new one is like building a new island, or silo, replicating governance, management, infrastructure which dramatically increases expense, causes fragmentation and duplication, when what is needed is greater reach, size and scope at lower cost.

oThe one critical success factor for successful physician practices is higher physician reimbursement rates. ECH does not have better physicians rates, and this is plan does not achieve them. Once a medical foundation is set up and running (many fail from poor management), it takes many years to acquire better insurance contracts.

oA large enough group is needed to gain negotiating power, but physicians will not join without better rates. The only reason some independent physicians joined Stanford’s foundation was they offered the higher rates the Stanford faculty already had.

oECH also needs to be able to manage physician practices. Its record here is poor. At its Mountain View site started 6 years ago when it was to expand, all its initial physicians left to open local practices, citing poor management. Some of the new hires now plan to leave. Creating a new foundation does not decrease need for good management, it increases it. ECH has never shown it can do this successfully. Stanford already had successful management of medical practices when it started its foundation.

oECH needs to have highly competitive salaries. They are in fact below average, and correlate with the quality of physicians it attracts. It is hard to get good doctors to give up control of their private practices when there is poor management, below average salaries, and no better reimbursement contracts.

oECH might take on all the above risks if there were no alternative. However there is a much better alternative.

·If elected, I will press the Board to re-evaluate the assumptions of their plan, and to compare actual performance to their original projections. We have higher than average expenses, and much lower reimbursement; this recipe needs careful review before proceeding.

·If such review supports my concerns, I will propose exploring the better solution: joining a successful already operational medical foundation. They already have better reimbursement rates; these can be offered immediately. They have proven management competency. Once there are better reimbursement, higher salaries can be offered.

·PAMF and Stanford are both successful Foundation models. Unfortunately, they represent other hospital organizations, which have their own interests. They are each large enough they are unlikely to allow self-governance.

·However, Washington Township Hospital in Fremont, also a District hospital, and John Muir, are not geographic competitors which might threaten ECH independence. They each have successful Foundations with better reimbursement rates, and have thus stabilized the practices of their independent doctors. They are small enough that ECH joining brings enough advantage for them to allow us more autonomy.

·ECH has discussed forming its own Foundation many times, and apparently has so decided. It will be a very expensive and high risk venture. Let’s not spend unnecessarily to make our own when we can have better success for less risk and less money!

·The only requirement I would impose is that the ECH branch has local governance. Keep ECH accountable only to District residents!

·Other strategic partnerships. ECH can be a highly desirable partner to other large organizations, and a successful affiliation with Stanford, UCSF, or even Kaiser may overcome many of ECH weaknesses. Many other independent hospitals are already doing this to maintain their independence long-term.

oBusinesses: self-insured companies need a collaborative hospital partner and know-how. Many large firms are exploring ways to reduce healthcare costs for their own employees.

TING Principles Guiding us Forward

Summary

Principles I believe in.

Priciples to guide our future.

The Principles

EL CAMINO HOSPITAL SHOULD REMAIN INDEPENDENT AND ACCOUNTABLE ONLY TO DISTRICT RESIDENTS

·ECH is a public, non-profit community asset, accountable only to District residents.

·Like all independent hospitals, it depends on referring physicians for its business.

·If most its referring physicians belonged to one outside organization, that organization would control the ECG agenda more than the District residents.

·ECH needs a cadre of physicians beholden to no other organization to keep it independent. (For details, please read "Clinical Partnerships" under Priorities and Issues.

UNIVERSAL HEALTHCARE

·I believe affordable essential healthcare should be available to all citizens and residents of this country.

·There are tremendous political and financial pressures to maintain the status quo, but universal healthcare is available in every other first world country, and we can do it here too.

SINGLE PAYER WITH COMPETING PROVIDERS IS THE BEST WAY TO PROVIDE HIGH QUALITY AFFORDABLE CARE.

·Competition in healthcare should be at the integrated provider level, not the payer level.

·Competing payers would charge different premiums, offer different services, and create inequality and confusion.

·Fewer payers, or a single one, can set the rules and payments for covered services, and integrated provider groups compete to deliver the best clinical outcomes, and highest patient satisfaction.

·It represents “managed non-profit market competition”.

NOT FOR PROFIT

·The only way to make a profit in healthcare is to maximize premiums, and limit payments for care.

·Making money should not result in inadequate or no healthcare for so many Americans.

·There are so many ways to make a profit in America. Healthcare should not be one of them.

MEDICARE FEE FOR SERVICE IS NOT THE BEST PAYMENT SYSTEM – MEDICARE MANAGED CARE IS.

·Medicare is fee for service, with no cost containment for volume of services.

·Medicare Managed Care has a fixed budget, and provides care within that budget.

·Having a fixed dollar amount, a budget cap, is the only way to truly control healthcare costs.

·Insurers would raise every imaginable objection, but the fact is we already spend more per person than any country in the world. And other industrialized countries have better outcomes than we do.

INCENTIVES MUST BE ALIGNED AND REWARD OUTCOMES AND SATISFACTION.

·When doctors, hospitals and ancillary services are integrated, they function as a unit, not competing entities. Healthcare efficiency and cost control depends on individual providers working together.

TING: Current Problems with U.S. Healthcare System

Summary

What do I believe is wrong with the current U.S. healthcare system.

What Do I believe we should do about it.

UNITED STATES HEALTHCARE PROBLEMS AND SOLUTIONS

THE EXISTING SYSTEM AND PROBLEMS

·Uwe E. Reinhardt, the Princeton healthcare economist, spoke at ECH 30 years ago. He said, "in your most drunken moments, you could not invent a more bizarre and byzantine healthcare system". The humor in this is the truth in it.

·Our healthcare system is flailing because provider financial incentives are misaligned and encourage doing things rather than preventing problems. Hospitals get paid for filling beds and doing procedures. Physicians get paid for their volume of work, seeing people, prescribing, operating. The fragmentation of providers results in unnecessary competition, duplication and delays, in costly inefficiencies and medical errors. On top of all this, to be successful, for-profit insurers depend wholly on charging more and delivering less care.

·We spend more than twice the average for all developed countries for healthcare. (World Bank 2017). The following figure shows how much of an outlier the U.S. is compared to other developed nations. And the divergence is worsening. We have failed to provide adequate value in the largest sector of our economy at a time when there is such great need in other areas.

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Healthcare in the U.S. is the world's best for those who have access to it. That said, the major problems are:

·It is almost all for profit, which generates good returns for shareholders, but contributes to making healthcare expensive and difficult to obtain, especially for those who need it the most: those with pre-existing conditions. Socialized medicine is stigmatized, but Medicare can only be described as such, and is highly successful.

·Profit is the difference between premiums paid and payments for care. Precise administrative costs for Medicare vs private insurance is subject to debate, described here in the Politifact online resources.

·Medicare administrative costs are estimated in the 3-4% range, and private insurance 16-20% range. Savings from a single payer system has been estimated at $383 billion to $500 billion in the article above. Running an insurance company like a business means denying or charging very high rates for those with pre-existing conditions, having very high deductibles and capping payments.

·Fee for service payment systems encourage more service, more visits, more tests, and more care, not always better care. Doctors’ groups set up scanners next to hospitals to compete for reimbursement for these services, and the same is repeated for laboratory tests, outpatient surgery centers, cardiac testing, etc.

SOLUTIONS

Solutions should correct root causes, and the principles be clearly defined. I believe those principles should be:

·All Americans have a right to essential healthcare which should not only be for profit.

·National medical costs should be capped. We already spend more per person than any other country .

·Incentives should encourage managing population health through prevention, early detection, and prompt service, and reimbursement be on a per person per year basis, not based on volume of services (fee for service)

·There should be competition in the healthcare market on a level playing field, based on process, outcomes, satisfaction and costs. With the same per person revenue, who can provide the best outcomes and satisfaction? Profits will depend on efficiency, good service and good medical management.

·Whether there is a single or many payers is a political question; the fewer the number of payers, the more streamlined and level the playing field.

·Many needlessly fear Canada-like waiting times. They would not have those waiting times if they spent twice as much as they do now, which would still be less than we are spending now. Satisfaction will be achieved through free market forces, robust competition by large integrated providers.

·This may sound near impossible to achieve, given the obvious opposing political and financial forces, but it is what is needed and it is what is best for the country. It has been achieved in most other developed countries. It is being implemented in parts of the United States. Americans deserve and should demand this.